Certified Mail Receipt 7001 0360 0003 3804 6456 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR 4 HEALTH CARE ADMINISTRATION, O5 -2 93 4 “ Petitioner, AHCA NO.: 2005001748 2005001749 vs. COMMUNITY HEALTH AND REHABILITATION CENTER, INC., Respondent. / ADMINISTRATIVE COMPLAINT COMES NOW the AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA”), by and through the undersigned counsel, and files this Administrative Complaint against COMMUNITY HEALTH AND REHABILITATION CENTER, INC., (“Respondent”), pursuant to Sections 120.569 and 120.57, Fla. Stat. (2004), and alleges: NATURE OF THE ACTION 1. This is a negligence action to impose an administrative fine against Respondent pursuant to Sections 400.102(1)(a), 400.121(1){a), 400.022(1)(1), and 400.23(8)(b), Fla. Stat. (2004). AHCA also intends to impose a conditional rating effective September 20, 2004, pursuant to Section 400.23(7), Fla. Stat. (2004), Case No. 2005001749. JURISDICTION AND VENUE 2. AHCA has jurisdiction pursuant to Sections 120.569 and 120.57, Fla. Stat. (2004). 3. Venue lies in Panama City, Florida, pursuant to Section 120.57, Fla. Stat. (2004), and Chapter 59A-4, Fla. Admin. Code (2004). 4. AHCA is the regulatory authority responsible for jicensure and enforcement of all applicable statutes and rules governing skilled nursing facilities pursuant to Chapter 400, Part 0, Fla. Stat. (2004), and Chapter 59A-4, Fla. Admin. Code (2004). 5. Respondent is a for-profit corporation, whose 120-bed nursing home is located at 3611 Transmitter Road, Panama City, Florida. Respondent is licensed as a skilled nursing facility, license HSNF130470978; certificate number 11968, effective November 01, 2004 through March 31, 2005. Respondent was, at all times material hereto, a licensed facility under the licensing authority of AHCA and was required to comply with all applicable rules, and statutes. COUNT I COMMUNITY HEALTH AND REHABILITATION CENTER, INC. FAILED TO PROVIDE SERVICES NECESSARY TO AVOID PHYSICIAL HARM FOR ONE (1) OF SIXTEEN (16) SAMPLED RESIDENTS. Section 400.102(1)(a), Fla. Stat. (2004) ACTION BY AGENCY AGAINST LICENSEE; GROUNDS section 400.121(1)(a) DENIAL, SUSPENSION, REVOCATION OF LICENSE; MORATORIM ON ADMISSIONS; ADMINISTRATIVE FINES; PROCEDURE; ORDER TO INCREASE STAFFING Section 400.022(1)(), Fla. Stat (2004) RESIDENTS’ RIGHTS section 400.23(8)(b), Fla. Stat. (2004) RULES: EVALUATION AND DEFICIENCIES; LICENSURE STATUS Section 400.23(7), Fla. Stat. (2004) RULES; EVALUATION AND DEFICIENCIES; LICENSURE STATUS 6. AHCA realleges and incorporates paragraphs (1) through (5) as if fully set forth herein. 7. On or about September 20, 2004, AHCA conducted a complaint investigation survey at the Respondent’s facility. AHCA cited the Respondent for a Class pursuant to Section 400.23(8)(b), Fla. Stat. (2004). A class Il deficiency is promised the resident’s ability to Tl deficiency, a deficiency that the agency determines has com maintain or reach his or her highest practicable physical, mental, and psychosocial well- being, as defined by a accurate and comprehensive resident assessment, plan of care, and provision of services. A Class I deficiency is subject to a civil penalty of $2,500.00 for an isolated deficiency. g. On December 16, 2003 at 12:30 p.m., the resident, an 82 year-old, aphasic female, was found on the floor, having fallen out of bed. Respondent failed to properly assess the resident’s condition after the fall, did not timely obtain x-rays of the resident’s leg, failed to administer pain medication, and failed to transport the resident for treatment. Such failure to make accurate assessment, to make timely referrals, and to administer pain medication constitutes an intentional or negligent act materially affecting the health or safety of residents, pursuant to Sections 400.102(1)(a) and 400.022(1)(1), Fla. Stat. (2004). 9, Review of the December 16, 2003 Nurse’s Notes at 12:30 p.m. indicates, “[rJesident found on floor with SR (siderails) in up position and bed in low position, side and wincing when right knee palpated.” lying with head resting on pad, guarding 10. AHCA’s interview with the Risk Manager, conducted on September 20, 2004, revealed that the physician was notified on December 16, 2003 at 12:30 a.m., but he did not give any orders for the resident’s care. 11. The Nurse’s Notes of December 16, 2003 at 6:00 a.m. indicate that the physician was again notified the resident was “continue gaurding [sic] and wincing, favoring right knee.” The physician ordered an x-ray of the right knee, but no pain medication was given, and the resident was not sent to the hospital. An AHCA interview with Director of Nursing on September 20, 2004 confirmed these findings. 12. The next entry in the Nurse’s Notes is 8 1/2 hours later, at 2:30 p.m. The Nurse’s Notes state that the resident was exhibiting “facial grimacing, moaning during turning and repositioning. American Mobile Imaging (AMI) to be in to do x-ray today of the right knee. Will continue to monitor. Refused all medication this shift including pain medication.” 13. At 4:00 p.m. that same day, the Nurse’s Notes reveal, "[p]atient continues to grimace and hold right knee during turning and repositioning. Complains of pain. Lortab 7.5 mg. given. Dr. M. ‘Khan called per daughter's request.” An interview with the Director of Nursing conducted on September 20, 2004 confirmed that there was no cation except for the above dose documentation that the resident was given any pain medi of Lortab at 4:00 p.m. on December 16, 2003. | icates that the resident had a pm order for Lortab olled Drug Declining Inventory Sheet indicates that the me five (5) days prior to the ' Review of physician’s orders ind issued in October 2003. The Contr resident last received Lortab on December 11, 2003, so incident. 14. Nurse’s Notes of December 17, 2003 at 1:30 a.m. reveal that American Mobile Imaging was finally called some 19 1/2 hours after the original physician’s x-ray order at 6 a.m. on December 16, 2003. 15. The American Mobile Imaging form dated 12-17-03 reveals a time in of 12:28 p.m. and a time out of 1:25 p.m. The facility staff coded the x-ray request as "routine" although there were options for ASAP and Urgent. In a September 20, 2004 interview, the Director of Nursing acknowledged that the x-ray, which was not taken until thirty-six (36) hours after the resident had fallen out of bed, was not completed in a timely manner. 16. The x-ray was read that same day, and the impression was “fracture distal shaft of the femur.” 17. A copy of the contract between American Mobile Imaging and Respondent states, "[aJll procedures requiring patient contact will be performed on-site at the nursing home facility, seven days per week”. 18. The Nurse’s Notes dated December 17, 2003 at 9 p.m. reveal that Dr. Khan was notified of the fractured femur 7 % hours after the x-ray was taken, and an order was received to "get an ortho consult.” 19, In an interview with the Director of Nursing and the Regional Manager conducted on September 20, 2004, the Director of Nursing stated, "The reason the resident was not sent out because the community is having a difficult time with the not like for the facilities to send orthopedic physicians. The orthopedic physicians do their residents to the Emergency Room, especially if they are Medicaid patients. The resident should have been sent out to the ER immediately but we are following the physician's orders". When asked why the resident was not transported to the Emergency Room when the accident occurred, she stated, "When our staff sends orthopedic problems to the ER we will receive a rude call from the staff at the ER wanting to know why we sent them. If we had sent her out, they would have just sent her back with an order for a orthopedic consult". 20. On December 18, 2003, the resident was transported to Bay Medical Center, where she underwent an open reduction internal fixation with nail placement on her right leg. 21. The above facts indicate that Respondent was negligent in failing to properly assess and treat the resident after she fell out of bed, by failing to provide pain medication despite the resident’s non-verbal signs of pain, and by failing to ensure that x-rays of the resident’s right leg were taken in a timely manner. This is a violation of Section 400.102(1)(a), Fla. Stat. (2004), which alth or safety of a 22. states that an intentional or negligent act which materially affects the he ident shall be grounds for action by the agency against the facility. a violation of Section 400.022(1)(1), Fla. Stat. res 23. The above also constitutes (2004), which requires that residents have the right to receive adequate and appropriate health care and protective and support services consistent with the resident care plan, with established and recognized practice standards within the community, and with rules as adopted by the agency. _ 2 Section 400.121(1)(a). Fla. Stat. (2004) states, revoke or suspend a license, or impose an administrati violation per day, against any applicant or licensee for.. of s. 400.102(1).” “t]he agency may deny an application, ve fine, not to exceed $500 per .(a) A violation of any provision 24. The above constitutes a Class II deficiency pursuant to Section 400.23(8)(b), Fla. Stat. (2004). A Class I deficiency is a deficiency that the agency determines has compromised the resident’s ability to maintain or reach his or her highest practicable physical, mental, and psychosocial well-being, as defined by an accurate and comprehensive resident assessment, plan of care, and provision of services. A class II subject to a civil penalty of $2,500 for an isolated deficiency. The violations 2,500. deficiency is alleged herein constitute an isolated Class II deficiency and warrant a fine of $ 25. A conditional licensure status should be assigned to Respondent, pursuant to Section 400.23(7), Fla. Stat. (2004). WHEREFORE, AHCA demands the following relief: 1. Enter factual and legal findings as set forth in the allegations of this administrative complaint. 2. Impose a fine in the amount of $2,500. Respondent is notified that it has a right to request an administrative hearing pursuant to 120.57, Florida Statutes (2004). Specific options for administrative action are set out in the attached Election of Rights (one page) and explained in the attached Explanation of Rights (one page). All requests for hearing shall be made to the Agency for Health Care Administration and delivered to the Agency for Health Care Administration, Building 3, MSC #3, 2727 Mahan Drive, Tallahassee, Florida 32308; Michael Mathis, Senior Attorney. RESPONDENT IS FURTHER NOTIFIED THAT THE FAILURE TO REQUEST 4 HEARING WITHIN 21 DAYS OF RECEIPT OF THIS COMPLAINT WILL RESULT IN AN ADMISSION OF THE FACTS ALLEGED IN THE COMPLAINT AND THE ENTRY OF A FINAL ORDER BY THE AGENCY. Respectfully submitted this pay of Tel: bl 2005, Leon County, Tallahassee, Flonda. ly 22a Michael O. Mathis Fla. Bar. No. 0325570 Counsel for Petitioner, Agency for HealthCare Administration Bldg. 3, MSC #3 2727 Mahan Drive Tallahassee, Florida 32308 (850) 921-0055 (office) (850) 413-9313 (fax) CERTIFICATE OF SERVICE 1] HEREBY CERTIFY that a true and correct copy of the foregoing has been oe? ia day of Sal 4 , 2005 to: Carolyn Friday, served by certified mail on Administrator, Community Health and Rehabilitation Center, Inc., 3611 Transmitter Road, Panama City, Florida 32404. FINA \eAUEANAVAL No Michael O. Mathis, Esq.

Docket for Case No: 05-002834